Hi #econjobmarket, I am an applied microeconomist working on health economics. Here is an overview of my #JMP.

“Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal”

Full version here:
https://anamoura.site/files/MouraJMP.pdf

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An importance source of inefficiency in healthcare is excessive length of stay at the hospital due to lack of alternative care arrangements following a hospitalization (aka bed-blocking)

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Bed-blocking is associated with higher hospital costs, has potential detrimental impacts on patients' health & creates delays for elective care.

Despite growing concerns about bed-blocking across various countries, there is limited evidence on *how* to reduce bed-blocking

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Research question:

I investigate whether, and to what extent, the availability of nursing homes (NH) and home care teams (HC) reduces hospital bed-blocking

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Setting:

I focus in the Portuguese context my dataset contains the universe of inpatient hospital admissions at public hospitals in PT, for 2000-2015. Public hospitals have no financial motivation to prolong lengths of stay

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Empirics:

My identification strategy exploits 2 sources of variation.

1st, variation across regions and time in the availability of NH and HC teams originating from the staggered introduction of a public policy reform

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2nd, variation between patients who live in the same region & are admitted to the hospital in the same time period but have ≠ propensities to bed-block

Potential bed-blockers exhibit social needs (no family support, inadequate housing) that might hinder timely discharge

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I compare the length of stay of potential bed-blockers and the length of stay of regular patients, before & after the entry of NH and HC teams in a region, where ≠ regions experienced NH and HC entry at ≠ points in time (triple-differences)

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Findings:

1. Prior to NH and HC entry, potential bed-blockers stayed at the hospital substantially longer than regular patients (over 10 days longer)

2. NH and HC entry does not affect the length of stay of regular patients

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3. HC entry reduces the length of stay of potential bed-blockers by 4 days

4. NH entry only reduces the length of stay of potential bed-blockers for those with high care needs (stroke, recovery from surgery). Most potential bed-blockers are not complex enough to need a NH

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Can these reductions in length of stay harm patients?

I find that reductions in length of stay for potential bed-blockers are not accompanied by reductions in the intensity of treatment received at the hospital, nor by an increased prob of readmissions

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What happens to the beds freed up by reducing bed-blocking?

They do not remain empty! I find that they are used to increase the number of elective admissions (pulling patients off waiting lists, thus reducing waiting times for elective care)

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How much does the healthcare system save?

Not much... My conservative estimates suggest that HC teams generate a 26% reduction in the cost burden bed-blocking imposes on the healthcare system. But the overall amount is small bc bed-blocking is a relatively rare event

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Policy implications:

HC and NH target ≠ patients

HC teams are more effective than NH are reducing bed-blocking bc most potential bed-blockers are not sick enough to need NH care

Small savings suggest that, during my study-period, allocation of resources was about right

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If you read until here, thank you!

Feel free to browse the full version of the paper for all the institutional details, robustness checks, and additional analyses: https://anamoura.site/files/MouraJMP.pdf

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